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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION CR#:_off <br /> APPLICANT OFFICE USE ONLY <br /> Name: T W I ►J c C,eo k <br /> Address: ov ny Z n JOB#: 11005 ISSUE DATE: <br /> ! Ci ,State,Zi Code: V— ()p,J Imb APN 245— Dtb ,36 FEE DUE: <br /> Area Code -Telephone Number: EXP.DATE: DRIVEWAYS; <br /> STREET: <br /> SITE INFORMATION: AREA: v * QUAD <br /> Parcel Owner's Name: G Vi Va'F- ¢rct - TYPE: <br /> Site Address: p a b G vJ t 2 FORMS: 11 Al� <br /> S/ <br /> City,State,Zip Code: p NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> CONTRACTOR &$F <br /> ITY WIDTHS <br /> Name: FRONTAGE <br /> Address: <br /> Cit ,State,&)Code:_Area Code Tele hone Number: aRNV <br /> — <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Hi hway Rig -0f--Way on the <br /> T side of My.Qpi.}y approximately �F!Q. _ <br /> of w by installing __ 1 h <br /> VEm �' <br /> commence on or aboutfor_ Work will <br /> approximately days. <br /> i <br /> SKETCH(Separate sheet may be submitted) <br /> i <br /> I <br /> Will this project be self-installed? YES NO Contractor's License <br /> td:!CENTRALSERVICES`CLERICALiPUB•SV.WKVMSTER.PSIENCROACHRENTPERKATDRNEWAYDOC (10109) P 9012 <br />